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PAY APPLICATION NO. 5 (FINAL) <br /> CONTRACT SUMMARY: <br /> • 1 - Original contract amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 426.380.25 <br /> 2 - Additions approved to date (Itemize) (Nos. 1 & 2 ) . . . . . . . . . . . . . . . . . . . . $ 40,616.00 <br /> 3 - Deductions approved to date (Itemize) (Nos. none ) . . . . . . . . . . . . . . . . . . . . $ -0- <br /> 4 - Revised contract amount to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 466,996.25 <br /> STATUS OF ACCOUNT: <br /> 5 - Contract amount to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 466.996.25 <br /> 6 - Value of completed work to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $442,854.32 <br /> 7 - Material stored on site (Attach Schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ NA <br /> 8 - Less 0 per cent retained . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -0- <br /> 9 - Total earned less retained amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $442.854.32 <br /> 10 - Total of estimates previously approved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 411,118.96 <br /> 11 - Amount due this estimate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 31,735.36 <br /> CERTIFICATE OF CONTRACTOR: <br /> I (We) certify that all work for which this request for <br /> payment is made has been completed in full, according to the <br /> plans and specifications and terms of the contract documents. <br /> I (We) also certify that payment has been made for all just <br /> claims for labor, material and services in connection with the <br /> APPROVAL OF (ARCHITECT) (ENGINEER): work performed on all preceding estimates. <br /> The work of the project and this estimate have been <br /> examined and the amount shown is recommended for MIDWEST ASPHALT CORPORATION <br /> payment. Firm Name <br /> Signature Signade <br /> Date /o — DZ—95 Date / S <br />